Missouri Supreme Court Upholds Noneconomic Damage Cap for Medical Liability Verdicts

Our Take: Caps on noneconomic damages help limit the amount of megaverdicts that we’ve been seeing increase in regularity all over the country. Megaverdicts add an extra layer to how malpractice insurance companies and their underwriters determine how much a physician pays for malpractice insurance coverage. Megaverdicts typically are any verdicts that exceed $50 million dollars. We hope that more states pass caps on noneconomic damages and that their state supreme courts uphold them as constitutional.

The Missouri Supreme Court last month upheld the constitutionality of the state’s cap on noneconomic damages in medical liability cases, determining “the General Assembly had the legislative authority to enact statutory noneconomic caps.”

The Missouri Supreme Court previously invalidated a $350,000 cap on noneconomic damages because, at the time, medical negligence actions remained a common law claim. In their 2012 decision of Watts v. Lester E. Cox Medical Centers, the justices determined that under common law, any limits on the amounts juries can award would violate a jury’s constitutionally protected purpose of determining damages sustained by an injured party.

In response, the Missouri General Assembly passed legislation in 2015 that amended certain state statutes to make medical negligence claims a statutory cause of action for damages, replacing any previous common law cause of action, and restricting the recovery of noneconomic damages in medical liability cases to $400,000, or $700,000 for malpractice resulting in catastrophic injury or death. Gov. Jay Nixon signed the bill into law in 2015, and the caps have increased by 1.7% annually since.

At the heart of last month’s decision in Velazquez v. University Physician Associates, et al. was whether the General Assembly’s abolishment of the common law action for medical negligence and the institution of a statutory medical negligence cause of action remedied the constitutional invalidity of statutory caps on noneconomic damages in medical malpractice trials.

In the underlying case, Maria del Carmen Ordinola Velazquez sued University Physician Associates and several of its physicians for malpractice. Velazquez alleged the physicians negligently performed an elective tubal ligation by failing to suture her left fallopian tube properly, resulting in cardiac arrest, massive internal bleeding, additional surgeries, a complete hysterectomy, laceration of the bladder, urinary issues and painful intercourse. A trial court jury found the defendants liable, awarding Velazquez economic damages of $30,000 and noneconomic damages of $1 million.

University Physician Associates asked the circuit court to reduce the noneconomic damage award pursuant to the state’s cap limit. Velazquez opposed the motion, asserting the cap violated her right to a jury trial under the Missouri Constitution. The circuit court rejected Velazquez’s constitutional argument, determining she suffered a “catastrophic personal injury” and reducing the noneconomic award to $748,828. Velazquez appealed the decision to the Supreme Court of Missouri.

In a 5-1 majority, the state’s highest court determined the cap on noneconomic damages did not violate Velazquez’s constitutional right to a jury trial.

The justices distinguished their Velazquez decision from that of Watts v. Lester E. Cox Medical Centers by noting that “[m]edical negligence actions remained a common law claim until the General Assembly amended certain statutes in 2015. Specifically, the General Assembly amended §538.210 to provide in pertinent part: ‘A statutory cause of action for damages against a healthcare provider for personal injury or death arising out of the rendering of or failure to render healthcare services is hereby created, replacing any such common law cause of action.’”

Affirming that the constitution does not forbid the abolishment of rights previously recognized by the common law, the justices referenced the General Assembly using its constitutional authority to abolish common law negligence claims against employers and creating a statutory workers’ compensation scheme as an example.

“It is undisputed that the General Assembly possesses the authority to abolish common law causes of action,” wrote the majority. “Because a medical negligence action is a statutorily created cause of action, the General Assembly had the legislative authority to enact statutory noneconomic damage caps.”

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